Provider Demographics
NPI:1164438370
Name:BROWN DRUG CO INC
Entity Type:Organization
Organization Name:BROWN DRUG CO INC
Other - Org Name:VALLEY GRANDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-875-2271
Mailing Address - Street 1:7171 AL HIGHWAY 22 N
Mailing Address - Street 2:
Mailing Address - City:VALLEY GRANDE
Mailing Address - State:AL
Mailing Address - Zip Code:36701-9309
Mailing Address - Country:US
Mailing Address - Phone:334-875-2271
Mailing Address - Fax:334-875-2273
Practice Address - Street 1:7171 AL HIGHWAY 22 N
Practice Address - Street 2:
Practice Address - City:VALLEY GRANDE
Practice Address - State:AL
Practice Address - Zip Code:36701-9309
Practice Address - Country:US
Practice Address - Phone:334-875-2271
Practice Address - Fax:334-875-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1127843336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003697Medicaid
1995865OtherPK
0133669OtherOTHER ID NUMBER-COMMERCIAL NUMBER